ECP 2022 Abstract Book

Virchows Archiv (2022) 481 (Suppl 1):S1–S364 13 prominent morule formation and has a pure pattern. H-FLAC typi- cally presents ≥50% foetal morphology and is often associated with other conventional types of lung adenocarcinoma. These tumours have different molecular profile from conventional lung adenocar- cinomas, with very low frequency of KRAS and EGFR mutations. E-PS-21-012 A complex case of pulmonary tuberculosis with superimposed chronic cavitary pulmonary aspergillosis: clinical, cytopatho- logical, and genetic contributions G. Olteanu*, V. Tudorache, O. Fira-Mladinescu, N. Suppini, P. Hogea, I. Mihai, A. Chiri ț ă-Emandi *Spitalul Clinic de Boli Infec ț ioase ș i Pneumoftiziologie Dr.Victor Babe ș Timi ș oara, Romania Background & objectives: We aim to present the clinical, cytopatho- logical, and genetic evaluation of a 52-year-old female patient with a history of treated post-primary tuberculosis (TB), cavitary pulmonary aspergillosis, and bronchiectasis that presents with unexpected hem- optysis, fever, and weight loss. Methods: Chest high-resolution computed tomography (HRCT), and respiratory evaluations with additional bronchoscopy procedure for bronchial aspiration (BA), and bronchoalveolar lavage (BAL) were per- formed. Complete cytological evaluation with May–Grünwald–Giemsa (MGG) stain and special fungal stains were done on cytology smears from the BAL fluid. The pathological examination led to a genetics centre referral, in order to understand the precise diagnosis. Results: HRCT showed a massive cavitary lesion with an intracavitary mass in the RUL extending to the superior segment of the RLL, suggestive of a mycetoma. BA microbiological analysis on GeneXpert MTB/RIF was negative for TB. BAL cytology was remarkable for neutrophil granulocytosis and MGG stained thin fungal hyphae, with septation, and acute-angle (45°), or dichotomous branching, confirmed with Periodic acid–Schiff (PAS) and Grocott stain. Serologically, A. fumigatus IgG antibodies were positive. NGS on whole blood for suspicion of Common Variable Immunodeficiency (CVID) or Granulomatous disease showed 2 variants of uncertain significance (VUS) in the CFTR gene, that could be associated with cystic fibrosis, or a predisposition for bronchiectasis. Conclusion: We present the complex case of respiratory disease, treated post-primary TB with reactivation, with initially complicated pulmonary aspergilloma, that presently showed an active superim- posed chronic cavitary pulmonary aspergillosis (CCPA). Genetic evaluation for a patient with recurrent and unexplained pulmonary infections could be helpful in the differential diagnosis. Underlying genetic causes in adults could predispose them to chronic infec- tions and pulmonary disease entities. Finally, complex cases should include a multidisciplinary approach for the ultimate benefit of the patient. E-PS-21-015 Sclerosing pulmonary pneumocytoma (SSP) (sclerosing haemangioma) E. Baliou*, E. Psychogiou, P. Megas, D. Riga, A. Konstantinidou, M. Mauroeide, I. Vamvakaris *General Hospital of Thoracic Diseases of Athens "Sotiria", Greece Background & objectives: SSP is a generally benign entity, although it has been associated with metastasis to the regional nodes. This is a case seen mostly in adult female patients. Usually, is being detected as a small, solitary nodule on the chest x-ray film. Methods: A 67 year-old female patient was referred to our hos- pital with a history of cough and breathlessness. Chest x-ray showed a peripheral, well circumscribed, unique, pulmonary nod- ule, measuring 1,8 cm in diameter. Wedge biopsy was performed. Results: Grossly, the nodule was solid, tan or yellowish with occasionally cystic areas. Histologically, two cell types were distinguished among very sclerotic stroma. Hobnail looking cuboidal cells, resembling type II pneumocytes and arranging in a papillary and/or solid pattern with foci of haemorrhages [ TTF(+), EMA (+), CK7(+), SpBpr (+)] and a second com- ponent, which is more prominent, that is round - oval, small stroma cells, that they grow in sheet like pattern, with fine chromatin nucleoli and sparse nuclear grooving [TTF-1(+), CK7 focally (+),CD34(-), S-100(-), CD1a(-), Langherin (-)] .The double cell population and the absence of atypia helps us in the differential diagnosis with malignant entities as a papillary adenocarcinoma Conclusion: Sclerosing pulmonary pneumocytoma (SSP) is a rare benign lession, usually seen in females. Based on double cell population and the hyalinized stroma, the pathologists should always keep in mind this entity especially in frozen sections or on a small biopsy , since a benign diagnosis of SSP can make a great difference to the patient and to the surgent, and avoid a lobectomy. E-PS-21-016 Rare cases of coexistence of non-hodgkin lymphomas with lung carcinomas O. Tzaida*, E. Souka, G. Galanopoulos, L. Karelis, N. Baltayannis, M. Kotsopoulou *Metaxa Cancer Hospital, Greece Background & objectives: During long term follow-up 1.2% of oncological patients may experience new unexpected primary malignant neoplasms. Synchronous occurrence of lung carcinoma and lymphoma is very rare, less than 1%. We present two cases of non-Hodgkin B lymphomas coexisting with lung carcinomas. Methods: A Case: A 68-year-old male with a past medical history of splenic marginal zone lymphoma (MZL), presented with right lung tumour and right thoracic wall lesion. He underwent right pneumonectomy and partial thoracic wall resection. B case: A 77-year-old male with a medical history of MZL presented with left lung tumour. The patient underwent left pneumonectomy. Results: A case: Microscopically, the lung tumour was lung adenocarcinoma, intermediate grade. The thoracic wall lesion was a lymphocytic proliferation consisting of medium size cells with abundant immunoblasts. Immunohistochemical examination revealed a CD20(+), BSAP(+), BCL2(+), BCL6(+), κ- light chain (+), phenotype. A diagnosis of a diffuse large B cell lymphoma (DLBCL), probably a transformation of the splenic MZL, coexisting with a primary lung adenocarcinoma was suggested. B case: Microscopically, the tumour was a non-keratinizing squamous cell carcinoma, high grade with a coexisting small cell atypical lymphocytic proliferation. Immunohistochemical examination revealed a CD20(+), BSAP(+), BCL2(+), CD3(-), BCL6(-), cyc-d1(-) phenotype. A diagnosis of non-keratinizing squamous cell lung carcinoma coexisting with MZL was suggested. Conclusion: Coexistence of lung carcinomas and lymphomas is very rare. Such co-occurrence has been documented on rare occasions and includes Hodgkin and non-Hodgkin lymphomas (mainly B- cell ori- gin lymphomas: DLBCL, MCL, MALT) in combination with different S332